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Full text of "Navy Department BUMED News Letter Vol. 5, No. 7, March 30, 1945"

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RESTRICTED 




NAVY DhP\TLTME:NT 



a diqest of timelij information. 



Editor - Lt. Samuel Nesbitt, (MC), U.S.N.R. 



Friday, Maj'(gli:80.,.1945 



TABLE OF CQNTE13TS 



Resuscitation Methods 1 

Penicillin in Fusospir ochetosis 5 

Topical Use of Sulfonamides 7 

Pemcillin: Delayed Absorption 8 

Penicillin: Oral Administration 10 

Cerebral Hemorrhage 13 

Sugar Tolerance in Inactivity 14 



Rh Blood Factors 14 

Gastr oscopic Examination 1 7 

American Board Examinations 18 

Dental Equipment: Maintenance 19 

Chest X-Ray Examinations 19 

Sulphur as Mosquito Repellent 20 

Norton Medical Award 20 



Public Health Foreign Reports.. .................... 32 

FQ^m Letters: 

Establishment of Naval Hospital at Dublin, Georgia. 

Military Government Hospital 202, Saipan, M.I 

Dental Operations and Treatments, Recprding of 

Army Publications, Supplemental List of.. 

Quarantine with Reference to Aircraft and ■passengers............. 

Penicillin Therapy, Report of Results of 

Transfer of Hospital Patients 

Spectacles for Personnel on Active Duty 

Physical Examination of Enlisted Personnel...... 

Gfeii^inated Solvents, Health Hazards of 



SecNav 21 

SecNav 21 

BuMed 21 

BuMed 22 

BuMed...... 23 

BuMed 24 

JointLtr 25 

BuMed 27 

JointLtr..... 30 
BuMed...... 32 



rJg^&us citation Methods for Asphyxia : Statistics on the relative effective- 
ness of the various methods of applying artificial respiration are very inadequate 
A high percentage of successful resuscitations in a statistically, ad e qua te 
series is the only convincing basis for approval of any one method although 
this does not constitute evi-dence that such a method is superior to others for 



Burned News Letter, Vol, 5, No. 7 



which adequate data are lacking. There is great variability in the circum- 
stances of anoxic and asphyxial accidents, and there are many factors which 
determine the success of the remedial procedure employed. For this reason, 
extensive data are required for comparison of different methods. Conclu- 
sions for approved practice in the Navy must be based upon available field 
data as well as the physiological evaluation of the method in the laboratory. 

The relative merits of manual and mechanical methods of resuscitation 
have been discussed for many years. The most extensive survey to date , 
carried out by the American Medical Association, indicated that in approxi- 
mately 3,000 cases there was no significant difference In the effectiveness of 
manual and mechanical technics. In considering specific procedures or me- 
chanical devices, the degree to which they simulate normal respiratory phe- 
nomena is an important criterion. The most important single characteristic 
of any acceptable method is its immediate availability. When asphyxia exists, 
and may have existed for some time, a few seconds gained or lost may deter- 
mine the outcome. Our purpose is to review the present status of available 
methods. 

Great emphasis has been placed upon the value of training non-medical 
personnel in a single, simple, standardized procedure which can be carried 
out by one operator. This simplifies the problem of training large numbers 
of persons and establishes general acceptance of such a method by the public 
so that the immediate institution of resuscitative measures at the site of 
the accident is not interrupted by controversy as to the choice of method. 
The acceptance of a single method to avoid confusion among laymen does not, 
however, preclude either the teaching or the use of approved alternative 
methods by medical personnel. 

Manual Methods : The Schaefer prone-pressure method is sponsored by 
the National Research Council, the American Red Cross, the Bureau of Mines, 
the American Gas Association and other scientific and rescue groups. In- 
dustries, such as American Telephone and Telegraph Company and the Con- 
solidated Edison Company of New York, employ it as a standard technic. 

The effectiveness of the Schaefer method has been demonstrated in the 
experience of the American Gas Association which reports 1,247 lives saved 
in a ten-year period due, "beyond all question", to the use of this prone 
pressure technic. Wills MacLachlan, whose survey was of cases of electric 
shock, also reports that 448 of 627 lives were saved by manual prone pres- 
sure. The relatively high percentage of successes in the MacLachlan series 
is especially significant because of the probability that it included a number 
of cases of ventricular fibrillation. 

The Eve tilt-table method of resuscitation, which was originally d e - 
scribed in 1932, has received attention and favorable comment and has been 



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adopted officially by the British Navy as. an alternative method. While it can- . 
not be classified strictly as a manual method because of the iact that It in- 
volves the use of equipment, the physiological principles involved are sound 
and experimental trials have been favorable. The equipment is minimal and 
can be constructed from items which are generally available. It should, how- 
ever, be set up and ready if it, is to be used in emergencies. There are no 
available records of resuscitation of a non-breathing victim by the Eve method, 
and there is no evidence to support the extreme view that the Schaefer method 
■ should be discontinued in favor of the Eve technic. 

Other manual methods include the Sylvester, the Holger-Nielsen> and 
the Drinker-Combined methods, all of which have all been used to some ex- 
tent. Although there are notssufficient clinical data to establish the ef f e c- 
tiveneSl of these technics, laboratory tests have shown that adequate ventila- 
tl0ii- can be attained in both conscious and anesthetized subjects by their use. 

The Sylvester method is performed by a single operator. In the expira- 
tory phase the chest of the subject is compressed while he is supine with 
forearms crossed over the chest. . In the inspiratory phase the subject's arms 
are extended laterally and cephalad, lifting and expanding the thoracic cage . 

In the Holger-Nielsen method a single operator kneels at the head of the 
prone victim. Escpiration is effected by exerting pressure on the scapulae of ■ 
the subject, while inspiration is brought about by grasping his elbowS; and 
lifting the aarms dorsad ajid cephai*#^ V - 

,The Drinker-Combined method utilizes the prone pressure of the Schaefer 
method and the arm lift of the Holger-Nielsen methody so that two operators 
are required. 

Mechanical Methods : The use of mechanical resuscitative devices is 
appropriate only when circumstances preclude the use of manual methods. 
Such devices should be considered as supplementary to traditional manual 
methods and not as substitutes for them. ' 

There is a clearly defined need for mechanical resuscltators in the Navy. 
In air-sea rescue boats, heavy seas and space limitation may impose severe 
restrictions on the use of manual methods. These restrictions may also apply in 
rescue operations at sea on lifeboats . Resuscitative measures employed on naval 
vessels may have to be applied to men in relatively inaccessible spaces o r 
who ate piraied beneath damaged structures. Space limitation in multitiered 
bunks in aircraft engaged in air-sea rescue or transportation of wounde d 
also makes it necessary to use mechanical devices. 



Requirements and Essential Equipment for Mechanical Resuscitation: The 
Committee on Industrial Medicine of the National .Research Council has approved 



Burned News Letter, Vol. 5, No. 7 RESTRICTED 



employment of mechanical devices where manual methods are not feasible. 
The Committee specified that mechanical devices have the following general 
characteristics: Be as simple mechanically as possible; (2) be as small 

and light as possible; (3) provide only positive pressure with a limit of 10 mm. 
Hg.; (4) provide no negative pressure." 

. ' The Bureau of Medicine and Surgery concurs in these resolutions, except 
that final decision as to the maximal pressure at the mask be deferred pend- 
ing further studies as to resistance to airflow. It recommends the addition 
of accessory equipment including a bellows for use when oxygen is not avail- 
able, a hand-operated aspirator and airways, ■ 

Field tests and an evaluation of mechanical resuscitators which conform 
to these requirements are now in progress at various naval activities. 

There is no adequate basis at present for selection of any one method, 
either manual or mechanical, except its immediate availability. Physiologi- 
cally one method appears to be as effective as another. However, the circum- 
stances of an accident may preclude the use of one or the other technic. For 
example, the Eve method, or certain mechanical methods, may have consider- 
able advantage where prolonged application of artificial respiration is required 
for maintaining respiration. Similarly, if a victim is pinned beneath structural 
debris, it may not be possible to apply the prone pressure technic, whereas the 
arm lift of the Holger-Nielsen method could be used. In another situation the 
victim might be supine so that only the Sylvester method or mouth -to-mouth 
insufflation would be possible. 

Thus it is apparent that if medical and hospital corps personnel are famil- 
iar with a number of procedures, it will greatly increase their resourcefulness 
and success in applsring artificial respiration in difficult and unusual situations. 

More information regarding the circumstances and effectiveness of resus- 
citative measures in the field is needed. To this end a multiple address letter 
to all ships and stations has been issued (N.D. Bull, of 15 Feb 1945, 45-146; 
Burned News Letter, Vol. 5, No. 6) requiring reports on all cases re ceiving 
artificial respiration. From this source, data will become available on a sub- 
ject which has been a center of controversy for over thirty-five years, and 
methods and equipment may be evaluated on the basis of accumulated facts 
rather than arbitrary opinions. (Nav. Med. Res. Inst., B. G. King; Res . Div.,^^ 
BuMed - J. N. Stannard) 

+ + 

A number of manufacturers of equipment used in resuscitation are attempt- 
ing to develop machines which will meet the above-mentioned requirements, and 



some that appear to be. satisfactory are ready for production. When they be- 
come available through the Medical Supply Depots, announcement to that effect 
will be mad#^ip the Burned Hew$. Let^^ 

*jte 3k ate aik sfe^ 
^JT^ *p 

Efficacy of Penicillin in the Treatment of Oral Fusospirochetosis: Studies 
which were started in March 1944, by Looby et al at the Dispensary, Philadel- ' 
phia Navy Yard, indicate that penicillin is effective in the treatment of or al ■ 
fusospirochetosis. . The intramuscular admiMstration of penicillin, Which, was 
employed in 52 cases, was slightly more effective than its use by topical ap.-/ 
plication which was the method used in 53 cases. 

Penicillin was given intramuscularly every three hours in doses of 20^000' 
Oxford units C5 injections) or 25,000 Oxford units (4 injections), the total dose 
being 100,000 units. Local application was carried out by spraying the gums 
with 10 c.c. of a solution containing 250 units of penicillin per c.c. in physio- 
logical saline. This was followed by swabbing the area withthe same solution. 
A folded piece of sterile dental napkin gauze saturated with this solution was 
then placed directly on the lesions and held in place for 30 minutes. Each ■ ■ 
patient received such an application three times each day for a period of one 
to five days, each treatment utilizing 3,250 units. 

^1' Those patients with acute and subacute gingivitis improved promptly fol- 

lowing penicillin therapy, but the chronic cases showed much less response. 
Spirilla and fusiform bacilli were absent or greatly reduced in number follow- 
ing such treatment in the great majority of cases. Follow-up studies made it 
clear that penicillin is not a cure for oral fusospirochetosis. The acute infec- 
tion subsided promptly, but it was necessary to employ other measures subse- 
quent to the penicillin therapy in order to obtain lasting results. 

. Investigations carried out at the Naval Medical Research Institute also 
showed that topical application of sodium penicillin (500 to 1,000 units per c.c.) 
in saline reduced or eliminated oral fusospirochetosis. These treatments were 
given twice daily for three or four days. ' • 

--- 'I 

Scrivener, at the U. S. N. Training Center, San Diego, observed the changes 
that took place in the mouths of 15 men undergoing penicillin treatment for 
gonorrhea, these men receiving a total of 100,000 units. In all cases there was 
a d^inite. decrease in the number of bacteria, particularly of cocci and spirilla, 
found in the saliva following treatment with penicillin. Not only was the num- 
ber of Vincent's organisms reduced in every case, but also inflamed gums 
■ showed considerable improvement. Although the counts of L. acidophilus were 
slightly IcWsered, there Were no dmhgefS in saltimry acidity md no ^agwj»iible 
effect upon susceptibility to dental- ca^fieg. 



Burned News Letter, Vol. 5, No. 7 RESTRICTED 



Strock administered penicillin intramuscularly and locally in doses much 
larger than those used by Looby et al. In all cases there was prompt improve- 
ment of the gingival lesions, and the numbers of oral fusiforms and spirilla 
were sharply reduced. (J.A.D.A., Sept. '44) 

A study of the efficacy of penicillin in the treatment of Vincent's stoma- 
titis was also made at Lowry Field, Denver, Thirty-two patients were given 
local applications three times daily for from one to three days. The total dosage 
varied from 48,000 to 116,000 units. Before each treatment the mouth was 
sprayed with water to remove debris. The ulcerated areas were dried and 
drops of concentrated penicillin (100,000 units per c.c.) were applied. After two 
minutes the gums were sprayed with 6 c.c. of saline containing 300 units of 
penicillin per c.c. The results were, in general, comparable to those pre- 
viously described. (Bull. U. S. Army M. Dept., Feb. '45) 

Sweeney et al treated 43 patients with Vincent's stomatitis at Bushnell 
General Hospital. All were given penicillin intramuscularly in doses of 
25,000 units every three hours; the average total dose was 721,000 units . 
After 48 hours of therapy, it was usually impossible to find fusiform bacilli 
and spirochetes except in those patients who had marked dental caries. 
(J. Lab. & Clin. Med., Feb. '45) 

Successful treatment of ten cases of fusospirochetosis by the use of peni- 
cillin lozenges has been reported from the U. S. Naval Air Station Dispensary, 
Corpus Christi, Texas (Aviation Supplement to Bumed News Letter, Vol. 4, 
No. 6). The lozenges, each containing 2,500 units, were given at one to 
three hour intervals for one or two days. 

The nature of fusospirochetosis and the relative merits of various methods 
of therapy have been discussed previously in the Bumed News Letter, ( Vol . 2, 
No. 13 and Vol. 4, No. 10). Special reference has been made to the ineffective- 
ness of arsenicals, as shown by the development of Vincent's infections in pa- 
tients who were receiving intensive arsenotherapy for syphilis. It has also 
been emphasized that fusiform bacilli and spirilla are common inhabitants of 
the normal mouth. Under certain conditions they may become pathogenic and 
act as secondary invaders. The factors (mechanical, nutritional, infective, 
etc.) which permit development of fusospirochetosis are numerous 
and often obscure, and they must be eradicated whenever possible in order to 
obtain optimal results. It is clear, however, that complicating infection with 
Vincent's organisms themselves may itself become serious and require 
separate treatment. For this purpose penicillin, given in several different 
^ ways, has proved to be of great value and can be expected to cause improve- 
ment within one to three days. (Res. Div., BuMed - L. E, Young) 

+ + + * + * 



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BwaaMff^^ Letter RESTRICTED 



Hazards of External Use of Sulfonamide Compounds : During recent years 
numerous preparations containing sulfonamide compounds, usually sulfathia- 
zole, ftave become available, and their use has been advocated for local treat- 
meat of minor lesions of the skin and orificial mucous membranes. Such prepa- 
rations may have certain immediate advantages over the older and conventional 
measures in selected cases, but their indiscriminate use is to be deplored, not 
only because of the uncertain results, but also because of very definite potential 
hazards involved in such use. 

The topical application of such sulfonamide compounds is generally effec- 
tive against chancroid, ecthyma and superficial primary pyogenic infections, 
such as impetigo. Such treatment is of slight benefit in pyodermas complicat- 
ing inflammatory eruptions and is of little or no value in other skin diseases. 
Despite these facts, sulfonamide preparations are being used to treat all types 
-of dermatoses, lesions of the mucous membrane and traumatic injuries, per- 
haps without realization of the possible dangers involved. 

The principal reaction which may occur as a result of the external use 
of a sulfonamide compound is the development of a dermatitis, which at first 
does not differ from an ordinary contact dermatitis caused by any other sensi- 
tizing agent. The earliest manifestation of this reaction is an eruption about 
the primary lesion which may be vesicular, bullous, erythematous or papular, 
later becoming moist, crusted and scaly. I£ the treatment is not discontinued, 
there will occur within a varying, but usually short period of time, a more 
diffuse eruption which may become generalized. This is a sensitization or an 
allergic tjrpe of reaction, and is most often of the eczematous type. Other types 
of reactions observed have been angioneurotic , urticarial , scarlatinif orm , morbil- 
liform, erythema multiforme -like and pemphigus-like. These manifestations 
will become more extensive and severe if the drug is continued. The eruption 
will usually disappear within a short period of time if the cause i s recognized 
and removed and soothing applications employed. . Occasionally the eruption 
may persist for a long period of time, may increase, in severity and rarely 
ieath may occur. 

ff 

Because of the sensitizing properties of the sulfonamides, it is possible 
that their topical use may preclude the internal administration of the drugs 
• when this may become urgently indicated. The sulfonamide compounds have 
been shown to cause hemolysis in vitro, and when applied to open wounds, they 
Cnay encourage bleeding. Delayed healing time of surgical wounds which are 
not infected has also been attributed to local application of sul- 
fonamide drugs. 

Reports indicate that" reactions from the topical application of the sulfona- 
aal^^' drugs ar@^ii^i^!&iasiI^g in occurrence and are more frequent than is recognized* 
The Is^spflMlmtt «pf i^mm .^^^pusttwti sli©isyid te.r#^Eicted and definite 



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Burned News Letter, Vol. 4, No. 7 RESTRICTED 



precautionary measures should be employed. The topical administration of the 
sulfonamides should be limited to chancroidal and primary pyogenic inf e c - 
tions of the skin. In the latter, perhaps, they should be used only after other 
measures have failed. The duration of the application should be limited t o 
five days, as sensitization reactions frequently occur if the applications are 
continued beyond this period. Also, sensitization as a result of treating a 
minor ailment may contraindicate the internal administration of sulfonamides 
at a future time when its use would be of utmost Importance, The use of these 
preparations, of course, should be abandoned promptly at the first evidence of 
any untoward reaction. (South. M. J., Feb. '45 - C. W. Lane; Arch. Dermat. & 
Syph., Nov. '44 - E. W. Abramowitz) 

Penicillin: Delayed Absorption Methods : When penicillin is injected intra- 
muscularly or intravenously it is rapidly excreted in the urine, and an effec- 
tive therapeutic level in the blood stream is rarely maintained for as long a s 
two hours after injection. Recent experiments have indicated methods of pro- 
longing an effective level of penicillin after injection. It has been suggested 
that the rate of renal excretion of penicillin may be retarded by the simultane- 
ous injection of diodrast (1) or para-aminohippuric acid (2) , Methods for d e - 
laying the absorption of penicillin have been studied which include prolonged 
chilling of the injected muscle (3) , the addition of epinephrine to the penicillin 
dose (4) and combining the penicillin with a special vehicle. Armstrong et al . 
(5) have suggested that when penicillin is injected intramuscularly in a 5 per 
cent dextrose solution, it is demonstrable in the blood for a significantly 
longer period than when the vehicle utilized is the usual physiological salt solution. 

Of the delayed absorption methods the work of Romans ky (6, 7) has given 
encouraging clinical results. He has found that high potency calcium penicillin 
(IjOOO Oxford units per mgm.) can be suspended in a 6 per cent mixture of bees- 
wax in highly refined peanut oil of low moisture content so that 1 c.c. of the 
mixture represents 300,000 Oxford units. For this purpose sodium penicillin 
is not suitable because of its hygroscopic qualities. Penicillin in this mixture ^ 
has been found to be stable for a period of over six months at 37^0. The use' 
of highly purified U.S. P. sun-bleached beeswax resulted in practically little or 
no irritation, a slight soreness being noted up to 24 hours at the site of the in- 
jection. The intramuscular injection in man of 300,000 Oxford units in 1 c.c. 
of this mixture provided detectable blood levels for 24 hours, and with 600,000 
units the same effect was prolonged to 28 hours. In each case penicillin could 
be detected in the urine for about 72 hours after a single dose. Romansky has 
treated 222 patients with gonorrhea with a single injection of calcium penicillin 
given in this manner. In 100 patients given 100,000 Oxford units there were 7 
failures, all of the latter being cured upon retreatment with a single dose of 
150,000 units. In the remaining 122 patients of this group given a single dose 
of 150,000 Oxford units there were no failures. , ^ 



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Many patients with staphylococcal infections of varying severity have , 
been treated with single or multiple injections without failure. The largest 
dose used in these cases was 200,000 units, which produced apersistent 
blood level for about 16 hours. Thirty patients with pneumococcus pneu- 
monia have been treated successfully with 4 daily doses of 200,000 units each. 

Twenty-five patients with early syphilis have been treated with 8 daily in- 
jections of 300,000 units each (total 2.4 million units). One patient with late 
syphilis received an injection daily for 20 days. There was no evidence of local 
or systemic reaction. In all of these patients a detectable level of penicillin 
was constantly present in the blood throughout treatment, and urine excretion 
of penicillin persisted for two to three days after the last injection. Twelve of 
these patients have been followed for over five months. All have become sero- 
negative at the same rate as after comparable dosage of aqueous penicillin. No 
Eelapses have been observed. 

No immediate allergic reactions were observed, but 4 of 350 patients d e - 
veloped hives and angioneurotic edema six to eight days following treatment. 
Seventy patients were skin-tested with oil, wax and penicillin before and after 
treatment with negative results. 

Chow and McKee (8) have combined crystalline penicillin with human plas- 
ma protein to make a penicillin-protein complex. They have isolated this com- 
plex in a state of at least partial purity as a dry powder which appears to retain 
full antibiotic power . This colloid is apparently much more slowly absorbed from 
the site of injection and more slowly excreted by the kidneys than is free or un- 
bound penicillin. Since the protein in this complex is normal human albumin, the 
penicillin-protein complex may be found to be nontoxic and nonantigenic in man. 
The therapeutic efficiency of this new colloidal penicillin is now under Investigation. 

Parkins et al (9) have combined sodium penicillin in a vehicle conteining 
from 6 to 20 per cent ossein gelatin and a long-acting vasoconstrictor drug 
(Privine or Neo-synephrine) so that 1 c.c. contained 5,000 or 10,000 Oxford 
units. Following a single intramuscular injection in patients of 1,000 units per 
kilogram of body weight, blood concentrations of penicillin were maintained at 
measurable levels for from seven to eight hours. 

Methods of prolonging the effective therapeutic level of penicillin in 
the blood stream have given encouraging clinical results and hold much prom- 
ise for the future. ' It should be emphasized that these methods are still in the 
ex^%rimental stage and ^© mot at present adaptable for general use. 

T^j;pT„IOQRAPHY-. 

(1) Rammelkamp, C.H., and Bradley, S.E.: Proe. Soc. Escper. Biol. & Med., 
.#3:29, '43.- ;M^-Vi -; ; ■ hnv ■ -*o^^Tv 

(2) Beyer, K.H. et al: Science, 100:107, '44. 



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Burned News Letter, Vol. 5, No. 7 RESTRICTED 



BIBLIOGRAPHY fCont.) : 

(3) Trumper, M. and Hutter, A.M.: Science, 100:432, '44. 

(4) Fisk, R.T., Foord, A.G., and Aller, G.: Science, 101:124, '45. 

(5) Armstrong, CD., Halpern, R.M. and Cutting, W.C.: Proc. See. Exper. BioL 
& Med., 58:1, Jan. '45. 

(6) Romansky, M.J. and Rittman, G.E.: Science, 100:196, '44. 

(7) Romansky, M.J.: Unpublished data. 

(8) Chow, B.F. and McKee, CM.: Science, 101:67, '45. 

(9) Parkins, W.M. et al: Science, 101:205, '45. 

Penicillin : Methods for Oral Administration : It has been accepted generally 
that the various salts of penicillin i n aqueous media cannot b e administered 
orally because of their rapid inactivation by gastric acidity. Available data in- 
dicate that penicillin is absorbed from the small intestine. Recent investiga- 
tions have been undertaken in an effort to devise a method whereby penicillin 
administered by mouth might be protected from gastric acidity and be available 
for absorption from the small intestine. 

Libby (1), utilizing the fact that little if any fat-splitting takes place in the 
stomach, and that most of the digestion and breakdown of fats occurs i n t h e 
small intestine, prepared suspensions of the sodium and calcium salts of peni- 
cillin (150 to 300 units per mgm.) in cottonseed oil dispensed in gelatin cap- 
sules containing 10,000, 25,000 or 50,000 units per capsule. Following the oral 
administration of a single dose of approximately 90,000 units of sodium peni- 
cillin in this manner to a man weighing 86 kilograms, maximal amounts of peni- 
cillin were found in the urine during the first two hours, decreasing to 1.8 units 
per c.c. eight hours after administration. Blood levels of approximately 0.05, 
0.04, 0.04, 0.02 and zero units per c.c. were obtained at 1, 2, 4, 6 and 8 hours 
following administration. He suggests that such a dose may maintain a fairly 
uniform therapeutic blood level for a period of at least four hours, and that two, 
three or more intramuscular Injections of 20,000 units in aqueous solution would 
be required to maintain a comparable blood concentration over the same period. 
Following the oral administration of 90,000 units of penicillin in oil, with two 
subsequent doses of 20,000 units at three-hour intervals, a therapeutic blood 
level was maintained for a period of at least seven hours. It appeared that some 
penicillin administered in oil was inactivated, probably by gastric acidity, and 
optimum blood levels were obtained ^hen it was given with the subject fasting. 

Little and Lumb (2) found that the maximum range of penicillin activity oc- 
curred between pH 4.6 and 8.0. When penicillin in various media was incubated 
at pH 2.5 at 37*^C., its action was destroyed; penicillin in plasma and in milk 
was seriously affected and in raw egg was least affected. They concluded that 
some substance in egg protects penicillin against an acid medium. Tauro- 
cholate also had some protective effect. They believe that the bacteriostatic 
activity of the blood rose to satisfactory levels when human subjects were given 



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Burned News Letter, ¥ol. 5, No. 7 



alkali by mouth followed by penicillin in egg, and they are making afurther 
clinical^tedy of this. " 

McDermott et al (3, 4) have investigated the oral administration of calci- 
um penicUlin in corn oil and in peanut oil containing four per cent beeswax; 
and of 'sedtem-ji^nfciliin to Wirt ©tUiie* «i©n@f ©r f i^eeBied by magnesium tM- 
silicate as a buffer. All subjects were kept in a fasting state throughout the 
period of observation. Following the oral administration of 315,000 units of 
penicillin in these various media the serum concentrations ranged from 0.312 
to UZb units per c.c. a4 iGf^ trr '60 naintit^s afte^^ and it appeared that 

concentrations of approximately the same orde?- ®fs,.magnitude were attained 
regardless of the media. The highest concentration of 1.25 units per c.c, at- 
tained at two hours, followed the use of the oil and beeswax preparation. Only 
a fraction of the ingested penicillin appeared in the urine during the succeed- 
ing IS hottfs. Th^ total urinary excrgdleffa'diaMsf^ this period ranged from 6 to 
32 per cent, but in the majority of cases was approximately 12 per cent. Studie 
of the serum concentrations and urinary excretion of penicillin following simple 
oral doses of 100,000 and 50,000 units by the four methods yielded results simi 
lar to those obser^md 'WS^ the 315#0® uaaii'dogfe.: .1; would appear that approxi- 
mately five times as much penicillin administefsfti'iorally is required to obtain 
a serum level comparable to that which is attained following intramuscular in- 
jection. 

Five male patients with gonorrheal urethritis have been successfully 
treated by the oral administration of penicillin in corn oil, and there have been 
no known relapses. The first three received excessive doses. The next two 
reoeii@d 4§,(f0&uMt© esrerythr^ total). 
The clinical and bacteriological results were comparable to those following:::-'' 
the use of penicillin injected intramuscularly. The sixth patient was given 
ordinary sodium penicillin powder in a gelatin capsule. The dosage was 
50,000 units every three hours for six doses (300,000 units). The therapeutic 
result was as successful as that following the oralftteiinistration of penicillin 
in oil or the intramuscular injection of penicillin. 

Nine- cases of pneumococcal pneumonia due to organisms of several sero- 
logicai types have been treated. Although the severity of the illness varied, at 

least six patients were critically ill, and one was in severe diabetic ketosis . 
The amounts of penicillin administered orally in these cases were huge and, in 
retrospect, the dosages represented over -treatment with penicillin, but there 
was- hesitancy in seducing tQCs »^lil|rv iti^^ MmiM ^Thfe -MMi- -? 

regimen used in about half the cai^^ Has the use of approximately six times 
the average necessary intramuscular dose. Therapeutic results in all nine 
cases were excellent. Seven of the nine cases defervesced by crisis within 
the fit-st'lE tOci^ hourSi '-The other two patients, r-^overed quickly but theft? t; 
temperatures lysed and were not normal for 60 and 96 hou'rig-jespectively. In 



Burned News Letter, Vol. 5, No. 7 RESTRICTED 



no instance was a meal delayed or omitted, and no particular effort 
was made to rebate the dosage of penicillin in relation to meals. No gastric, 
intestinal or other complications were noted. No studies on gastric acidity 
were made. 

Charney et al (5) found that less penicillin was excreted in the urine when 
the drug was administered orally in water two hours after breakfast than when 
given after an overnight fast. The administration of trisodium citrate or di- 
sodium phosphate with penicillin to the fasting subject slightly increased the 
urinary excretion of penicillin. The administration of these substances with 
penicillin when given two hours after breakfast, resulted in approximately 
100 per cent increase in, the urinary excretion of penicillin as compared to 
the urinary excretion following administration of penicillin in water alone 
under the same conditions. There were large individual differences in urinary 
excretion of penicillin following oral administration. 

Gyorgy (6 ) has administered calcium penicillin orally in combination with 
trisodium citrate as a buffer. The drug was given in a dosage of from 20,000 
to 30,000 units plus 1 to 5 Gm. trisodium citrate in from 200 to 400 c.c. of water. 
This method of treatment was found to be therapeutically effective in gonorrhea, 
there being a clinical cure in 23 cases after a total dosage ranging from 200,000 
to 480,000 units which was giVen in three or four doses over a period of from 
12 to 24 hours. This combination of penicillin and buffer by mouth produced 
higher and more prolonged blood levels of penicillin than when penicillin was 
given alone. The peak blood level attained following the oral administration of 
40,000 units of calcium penicillin was 20.0 units per c.c, the average about 
eight units per c.c, and the average duration of a detectable blood level was 
from two to three hours. 

These experiments are interesting and show considerable promise of de- 
veloping a new method for the administration of penicillin. The present prob- 
lem is analogous to that involved in intramuscular injection and would appear 
to be the finding of the ideal vehicle as well as other factors whereby the dura- 
tion of the serum concentration of penicillin can be prolonged following its ad- 
ministration. 

These preliminary studies indicate that approximately five times the amount 
of penicillin is required when administered orally than when by intramuscular 
injection. It is possible that this increased use of penicillin may be offset by 
several factors. The ease of administration from the viewpoint of the physician 
as well as the patient is evident. Also, for oral use a less highly refined peni- 
cillin should be entirely satisfactory, thus simplifying the present procedures 
for the production of a suitable material. At present the supply of penicillin is 
limited. It is important to indicate that studies concerning the oral administra- 
tion of penicillin remain in an experimental stage, and these methods are not 
available for general use. 



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Biam©i llii!S® l)*t@ti;:^. f-' RESTRICTED 



RIBT..,IOaRAP.HY: ■. - . . 

(1) Llbby, R.L.: Spience, 101:178, '^1:^ ■ '•' - - • ' " ' - ^ - — 

(2) Little, C.J.H. and Lumb, G.: Lancet, Feb. 17, *45. 

(3) McDermott, W. et al: Science, 101:228, '45. 

(4) McDermott, W.: unpublished data. 

(5) Charney, J., Alburn, H.E. and Bernhart, F.W.: Science, 101:251, • 

(6) Gfyorgy, P.: J.A.M.A., March 17, '45. - ■ ■ ■ • ■ • 

9|: 3|c ^ if: ^ 

' Signs and Svm-ptoms of Impending Cerebral Hemorrhage : The tragic ab- 
ruptness with which cerebral hemorrhage ends the lives of comparatively 
young persons led to a search for methods whereby such deaths might be 
anticipated. An analysis has been made of the records of patients who died 
withj or of, essential hypertension in an attempt to determine whether or not 
there are enough points of similarity among those who had cerebral hemor- 
rhage to define an antecedent syndrome that segregates this group from other 
patients with essential hypertension. Studies of the heart and kidney can pro- 
vide with reasonable accuracy an estimate of the state of the coronary and 
renal vessels, but there are no means for a comparable analysis of the cere- 
bral circulation. Clinical findings have been the only evidence as to the in- 
tegrity of this important vascular bed. 

The records of 40 patients (average age 46.8 years) who died with essential 
hypertension were examined to determine whether or not the clinical courses 
of those who died of cerebral hemorrhage were similar enough to allow an ac- 
curate prediction of apoplexy. The data indicated that a clinical study of indi- 
viduals with essential hypertension may indicate a picture peculiar to those patients 
who are likely to have apoplexy. Patients in this series who died of cerebral 
hemorrhage presented concurrent findings that were uncommon among other 
patients with essential hypertension. An investigation of individual medical 
histories revealed that the average duration of the disease among thos e who 
died of apoplexy was 20 per cent shorter than those dying of other causes. Of 
this group 19 had fatal cerebral hemorrhages. Five signs and symptoms were 
consistently observed. These were: (1) severe occipital or nuchal headaches, 
f^rtigo or syncope, (3) motor or sensory neurologic disturbances, (4) nose- 
bleeds and (5) retinal hemorrhages in the absence of papilledema or retinal 
exudates. These findings were negligible or absent among those patients who 
died of other causes. It was concluded that the demonstration of any four of 
these manifestations in person^ wlfh essential hypertension warrants the assump- 
tion that death from cerebral hemorrhage will occur within 0.8to 5years (aver- 
age 2.1 years). (J.A.M.A., Feb. 17, '45 - R. D. Taylor) 

"^^h "^ji^ *^ ^i^" 



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Burned News Letter, Vol. 5, No, 7 



Effect of Prolonged Physical Inactivity on Sugar Tolerance: The effect 
of exercise on the utilization of dextrose is well known, and exercise in addition 
to diet and insulin has been accorded a prominent place in the treatment of 
diabetes mellitus. The fact that exercise increases carbohydrate metabolism 
does not necessarily mean that inactivity will do the opposite. Since the prob- 
lem may arise of interpreting values for sugar tolerance in patients confined 
to bed for considerable periods, Blotner has investigatedthe effect of prolonged 
physical inactivity on the carbohydrate metabolism in non- diabetic individuals. 

A study was made of the effect of prolonged physical inactivity on the dex- 
trose tolerance of 86 non-diabetic patients - 70 adults and 16 children - who 
had been confined' to bed for periods of one month to thirteen years because of 
various pathologic conditions. A comparison was made between the dextrose 
tolerance of these patients and that of active adults and children. 

It was found, in general, that the sugar tolerance was diminished in those 
patients who had been confined to bed for considerable periods. The fasting 
blood sugar in these cases ranged from 70 to 130 mg. per hundred cubic centi- 
meters, and the fasting urine was free from sugar. After the ingestion of dex- 
trose the concentration of blood sugar rose to abnormal levels, the maximum 
being 365_mg. per 100 c.c, and varying amounts of sugar were found in the 
urine at different times. In many of the adults there was a high renal thresh- 
old for dextrose. In some patients, who later became ambulatory for several 
months, the sugar tolerance returned to normal. Age did not appear to have 
a definite relation to the diminished sugar tolerance. Hypertension, vascular 
disease, obesity and infection in themselves did not appear to be significant as 
causative factors. 

The arteriovenous differences in the blood sugar of a group of inactive 
persons after the ingestion of dextrose ranged from 15 to 50 mg. per 100 c.c, 
which is normal or greater than normal. These results indicate that the mus- 
cles of the physically inactive, patients are capable of utilizing sugar normally. 

It is suggested that during prolonged physical inactivity the pancreas is at 
rest, because in this state there is not the demand for rapid storage and utili- 
zation of sugar that there is in active persons. Consequently, there may ensue 
diabetic-like reactions during dextrose tolerance tests even though the fasting 
levels of blood sugar are normal, (Arch. Int. Med., Jan. '45 - H. Blotner) 

The Rh Blood Factors : In the course of the recent rapid developments in 
the field of the Rh blood factors, it has become necessary to invent a special 
vocabulary to express the new ideas and to describe the new facts "which have 
been discovered. This vocabulary has been test-ed by actual usage and has the 



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Burned News Letter, Vol. 5, No. 7 



RESTRICTED 



approval of other workers to whom it was sent for opinion. The purpose of 
this communication is to publicize the vocabulary more widely for the sake 
of uniformity in the use of nomenclature by all interested in the subject. 

Anti -rhesus sera: Immune sera prepared in rabbits, guinea pigs, goats 
and other animals by injecting them with the blood of rhesus monkeys. The 
term applies to sera like the original experimental sera of - Landsteiner and 
Wiener, which agglutinate the bloods of 85 per cent of all white persons. 

Anti-Rho human sera : Human sera (usually obtained from mothers of 
erythroblastic infants) which give reactions paralleling the anti-rhesus sera; 
also known as standard anti-Rh sera. 

Rh testing : Examination of blood for the Rh factor, using either anti- 
rhesus sera or anti-Rho sera alone. 

Rh reaction: Result of- the Rh test, namely either Rh positive or Rh nega- 
tive. When the terms, Rh negative and Rh positive, are used as adjectives, " 
they should be hyphenated; e.g,, Rh-positive blood, Rh-negative individuals, 
but "the blood is Rh positive." 

Rh sensitization : The act of becoming sensitive to the Rh factor. This 
may occur in one of two ways: namely, as a result of a transfusion of Rh- 
positive blood or as a result of pregnancy with an Rh-positive fetus. Natural 
sensitivity to the Rh factor does not occur; and only 1 in 25 to 50 Rh-negative 
persons exposed to the Rh antigen by transfusion or pregnancy becomes sensi- 
tized. 

Rh factors are three in number, designated as Rho, Rh' and Rh" respec- 
tively. 

Rh agglutinins: The animal anti -rhesus agglutinins are all of the same 
specificity (85 per cent positive in white persons) . The anti-Rh agglutinins 
of human sera have three different specificities corresponding to the three 
Rh factors, namely anti-Rho (85 per cent positive in white persons), anti-Rh' 
(70 per cent positive) and anti-Rlf (30 per cent positive) . 

Rh agglutinogens; Rh antigens: These are five in number; Rhl (or Rho'), 
Rhg (or Rho") , Rh', Rh" and Rho. 

Rh antisera : Antisera reacting with one or more of the Rh factors. Among 
human beings, in addition to sera containing only one sort of Rh agglutinin, there 
are some with two Rh agglutinins. Five common varieties of human Rh antisera 
are anti-Rho, anti-Rh', anti-Rh", Anti-Rho' (containing two agglutinins, anti-Rho 
and anti-Rh') and anti-Rho". 



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Burned News Letter, Vol. 5, No. 7 RESTRICTED 



Rh genes : The series of allelic genes whicJi determine the various sorts 
of Rh agglutinogens and Rh blood types. The most common (the standard) genes 
are six in number: rh, Rh' , Rh", Rho, Rhl and Rh2. When discussing only the 
results of tests with the standard anti-Rho sera, dividing persons into two types, 
Rh positive and Rh negative, only a pair of genes need be considered, Rhandrh. 
Obviously, Rh-positive persons may be either homozygous (genotype RhRh) or 
heterozygous (Rhrh) , while Rh-negative persons are always homozygous (rhrh) . 

Rh blood types : Tests with anti-Rho , anti-Rh' and anti-Rh" yield eight 
standard types. The names of these types and their approximate frequencies 
among white persons in New York City are as follows: type RhlRh2, 13 per cent; 
Rh]_, 54.5 per cent; Rh2, 15 per cent; Rho, 2.5 per cent; Rh'Rh", one in about 
10,000; Rh', 1.'2 per cent; Rh", 0.3 per cent; and Rh-, 13.5 per cent. There are 
striking differences in the distribution among different races; for example, in 
Negroes type Rho exceeds 40 per cent; in Mongolian races Rh- is virtually ab- 
sent, and so on. 

Rh typing : Classification of individuals within one of the eight Rh type s 
with the aid of anti-Rho, anti-Rh' and anti-Rh" sera. Note the distinction be- 
tween "Rh typing" and "Rh testing." 

Rh genotypes: The six standard genes pair to yield twenty- one different 
genotypes. These twenty-one genotypes in turn fall into eight phenotypes 
identical with the eight Rh blood types, because only eight distinct types of 
blood can be distinguished with the anti-Rho, anti-Rh' and anti-Rh" sera. 

Rh classes: For convenience in analyzing genetic results, the classifica- 
tion of persons according to their reactions only with anti-Rh' and anti-Rh" 
is convenient. This yields four classes, W, U, V and UV, analogous to the 
four common blood groups. Each class includes a pair of Rh types as follows: 
class W, Rho and Rh-; class U, types Rhi and Rh'; class V, types Rh" and Rh2; 
class UV, types Rh'Rh" and RhiRh2. 

Hr factor: The factor present in the agglutinogens determined by genes . 
rh, Rho, Rh" and Rh2. Hence only persons belonging to type Rhi (provided 
they belong to genotype RhiRhi or RhlRh' ) or type Rh' (rare genotype Rh'Rh') 
can possibly be Hr negative-. Persons belonging to any of the other six Rh 
blood types are uniformly Hr positive. The common idea that infants with 
hemolytic disease due to the Hr factor are always Rh negative is wrong; such 
infants must in fact always be Rh positive. 

Anti-Hr serum: Serum capable of reacting with blood containing the Br 
factor. 



Hr tests : Tests with anti-Hr serum. 

- 16 - 



Blamed News ,¥|>I:* , J^z-^to*) 5 ' : . - < . Bl^yMCiTED 



Hr reaction : Results of the Hr tests, namely either Hr positive or Hr 
negative, .■ •T'.tr- t... . 

Rh incompatibility : Incompatibility based on difference with respect to 
one or more of the Rh factors. 

.H-p incompatibility: Incompatibility with respect to the Hr factor. 

Rh blocking serum (antibody) : A serum capable of reacting with blood 
containing the Rh factor but without producing agglutination, although blocking 
th@- action of subsequently added anti-Rh sera; i.e., Rh-positive blood treated 
with Rh blocking sera can no longer be agglutinated by anti-Rh sera. To date, 
blocking antibodies of only one specificity have been found, namely, anti-Rho. 
(J. A.M. A., Feb. 3, '45 - A. S. Wiener) 

****** 

The Value of Gastroscopic Examination in th e Diagnosis of Gastric Disease; 
SiH0e the invention of the flexible gastroscope in 1932 by Wolf and Schindler,' 
gaftj-oseopy has become a practical and valuable aid in diagnosis. 

It should be pointed out that complete examination of the stomach by us e 
of the gastroscope is impossible. For mechanical reasons, adequate visuali- 
= zation of certain regions of the stomach, especially the posterior wall and the 
lesser curvature below the angle, may be difficult. Lesions of the mid-portion 
of the stomach near the angle are most easily seen; lesions near the cardiac 
orifice are less readily visualized. Excessive gastric secretion and gastric 
spasm may increase the difficulties of performing thia procedure. 

Certain limitations of the procedure should be pointed out. Marked obesity, 
severe cardiac or respiratory disease, esophageal lesions and deformities of 
the vertebral column are contraindications to gastroscopic examination. Con- 
siderable discretion should be used in advising gastroscopy m 
patients who are of advanced age or who are unstable either from a nervous or 
emotional standpoint. Complications seldom occur after passage of the flexible 
gastroscope, especially when the examination is performed by an ejcpenenced 
gastroscopist. Although the risk is slight, this factor should be considered in 
the selection of patients. 

Gastroscopic examination is most commonly indicated when the results of 
roentgenographic study of the stomach have been negative and yet the clinical 
history is suggestive of organic disease. Occasionally the gastroscopist may 
demonstrate a gastric ulcer or neoplasm that was not seen on roentgenographic 
examination. Gastritis, which the- roentgenologist would not be able to discern, 
is th#,ai«itlte^^*' :Howeve#:, In the -g^^.^i^jrlty/tf -eases, j^^^^^^fi^^^tt^^ 



fit? - 



Burned News Letter, Vol. 5, No. 7 RESTRICTED 



of roentgenographic examination are negative, the gastroscopist likewise finds 
a normal stomach. 

In many instances, the roentgenologist requests gastroscopic examination 
in order to confirm either positive or doubtful roentgenographic findings. The 
gastroscopist may be able to assist in differentiating benign from malignant 
ulcers of the stomach. Caution must be exercised, however, by both the roent- 
genologist and the gastroscopist in attempting to make this differentiation as 
there is no substitute for microscopic examination of tissues involved. The 
gastroscopist also can be helpful in the differentiation of scirrhous carcinoma 
from hypertrophic gastritis. Again, differential diagnosis may prove to be dif- 
ficult. 

Gastroscopic examination may be of great value in following the progress 
of a gastric ulcer treated medically. By this means the ulcer frequently may 
be seen in the healing stages after all roentgenologic evidences have 
disappeared. Thus, repeated gastroscopic examinations may be of assistance 
in directing treatment. 

Gastroscopic examination of the stomach which has been subjected to 
operative procedures also may prove to be valuable. In fact, this procedure 
probably has its greatest usefulness in the evaluation of postoperative syn- 
dromes. Gastritis or ulceration at the anastomotic junction of the stomach 
and intestine may be demonstrated by this means. 

When adequate visualization is obtained, the appearance of gastric ulcer , 
gastric tumor and the well-developed forms of acute, hypertrophic, atrophic, 
ulcerative and erosive gastritis is striking and unmistakable. However, dif- 
ferentiation between normal gastric mucosa and the mucosa of milder forms 
of gastritis is often difficult. It is perhaps wise for the examiner to report 
only significant degrees of gastritis, that is, definite changes in the mucosa 
rather than mere variations in normal appearance. In the postoperative stom- 
ach it is particularly difficult to distinguish between postoperative mucosal 
changes and actual gastritis. 

The importance of this procedure should not be exaggerated nor should it be 
underrated. Gastroscopic examination should be considered as an added tool in 
the methods of diagnosis of gastric disease or for following the course of such 
disease rather than being utilized to the exclusion of other means, particularly 
roentgenographic examination. (Proc. Staff Meet. Mayo Clinic, Feb. 21, '45) 

+ + * + 3)t % 

America n Board of Internal Medicine : The next written examination of 
the American Board of Internal Medicine will be held on October 15, 1945. 



- 18 - 



b.estrtc:ted 



The final date for acceptance of applications is August 1, 1945.. Candidates in 
the Armed Forces may take the written examination at their station of duty 
with the permission of their senior medical officer. Further information may 
be obtained from the office of the Assistant. Secretary-Treasurer, 1301 Uni- 
versity Avenue, Madison 5, Wisconsin. . . . . 

Course of Instruction in Dental Repair and Maintenance : A four, months ' 
course of instruction in the repair and maintenance of dental equipment has 
been established at the U. S. Naval Training Center, Batabrldge, Maryland. 
The first class, which began on February 24, 1945, was composed often 
students selected on the basis of previous experience in the repair of dental 
equipment. A new course will start every four months. 

Applicants with marked mechanical aptitude, a basic knowledge of elec- 
tricity, and preferably with a background of experience in the repair of dental 
e.quipment, are encouraged to submit of ficial requests to dis- 
trict commandants for this course of instruction. It is desirable., tiiat such 
requests be supplemented by suitable endorsements and recommendations by 
dental officers in the field who have had' the opportunity to observe the candi- 
date's fitness for such work. District commandants will be assigned a quota 
Of Hospital Corps ratings of students eligible for^fvitiire classes. (Dentistry 
DlTv, BuMed - R. S. Davis) r ^ ■.. 

I ' ' - ■ ■ 

■■ ' i - ■ • t - ■ - .^^-^ . . . . , ; . ... i I.. V 

Roentgenographic Examinations: Certain misapprehensions have been 
reported concerning the intent of BuMed Ltr BUMED-Y-DFS, P3-33p3-lC054- 
40) dated 4 Jan 1945 which was published in the Navy Department Se mi - 
monthly Bulletin dated 31 Jan 1945 and reprinted in the Bumed News Letter, 
ToX. 5, m. %. 

The text of paragraph 3 of this letter indicated that roentgenographic ex- 
aminations of the chest shall be made, "at the earliest opportunity", and, 
**if practicable.'* TMs is interpreted to mean that when photofluorographic 
equipment is available, the routine chest examinations shall be made. In this 
connection, photofluorographic units have been placed in naval activities i n 
most continental ports, and in Navy #128, so that examination of the personnel 
Of naval vessels may be obtEined. 

It is the policy of the Bureau to establish stationary photofluorographic 
units only in locations where approximately 10,000 examinations maybe made 
each month. (Prev. Med. Div., BuMed - T. J. Carter) 



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RESTRICTED 



Ineffectiveness of Ingested Sulphur as a Mosquito Repellent : Sulphur dust 
or ointment was recommended as a chigger and tick repellent until the effec- 
tiveness of dimethyl- and dibutylphthalates was demonstrated. Recently it has 
been reported that the ingestion of sulphur or water with a high sulphur con- 
tent afforded protection against chiggers, mosquitoes and other biting insects. 

The effectiveness of ingested sulphur as a mosquito repellent has been 
investigated. One volunteer subject consumed 1,540 mg. of powdered sulphur 
in 385 mg. capsules daily for ten days and another subject 770 mg. daily for 
15 days. The bare arms of the test subjects as well as those of two control 
subjects were exposed daily in a cage containing 400 to 500 mosquitoes (Aedes 
aegypti ) and the average number of bites in three half-minute intervals was 
determined. There was no significant difference in the number of bites r e - 
ceived by the two groups. However, the subjects who ingested sulphur believed 
that the irritation and wheal formation produced by the bites were less severe 
than in the control subjects, and this fact is being further investigated. It may 
be concluded that the ingestion of sulphur within the dosage range studied i s 
ineffective as a repellent measure against mosquitoes. (Nav. Med. Res, Inst., 
Proj. 106 - L. Jachowski, Jr.) . 

^ ^ ^ ^ ^ 3{c 

The Norton Medical Award of $3^500 which is offered to encourage the 
writing of books on medicine and the medical profession for the layman for 
publication in 1946 has been announced. Further information maybe obtained 
from W,W, Norton & Company, Inc, 70 Fifth Avenue, New York 11, New York. 

* + + * + * 



- 20 - 



To: All Ships and Stations. Opl3-lD-psp 

■r- ! c:-:t; - - ' -^©rial 135213 
Subj: U. S. Naval Hospit^^ublin, G©o]?gia - 

EstablisJx^ent of. 8 Feb 1945 

1. The medical- department facilities at Dtiblin, Osorgia, str© established MB 
($t 22 January aad designated: .uc^i£j5 h';iaL 

U. S. Naval Hospital, 
Dublin, Georgia. 

This iB aai- a8ti'\?% of the Sixth Naval District. 

2. :^ureaus and offices concerned take necessary action. 

.., --SecNav. James FGrrestaL 

" ^ 

To; All Ships and Stations. ' ' Opl3-lD-psp 

Serial 14^613, 

Subj: U. S. Naval Military Government Hospital No. 202, 2 12 67 

Saipan, M. I. ^ 26 Feb 1945 

1 . The G-4 functional component of the Military Government at Saipan is 
hereby established^under a Medical Officer in Command and designated: 

■ U. S. Naval Military Government Hospital No. 202, Saipan, M. I. 

2. laijpli^^jaEd offices concerned take necessary action. 

— SecNav. Ralph A. Bard. 

To: All Ships and Stations. BuMed-D-HM 

P5-2 

Subj: Dental Operations and Treatments, Recording of. 24 Feb 1945. 

Ref:,, (a) Manual of the Medical Department, ch. 14, sec. VI. 

1. Improper or inadequate recording of dental treatment and dental charting 
is hampering this Bureau in cooperating with other Government agencies re- 
quiring such records for substantiation or verification of claimants' statements 
in adjudicating claims of persons separated from the naval service. The dental 
entries on NavMed H-4, NavMed Y, and NavMed 566 are often required by the 
Veterans' te d^^^^^^g||ii^1#Wte^t^>'f^*»^ dwbal 

treatment. 



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Instructions contained in reference (a) shall be carried out to insure accur- 
ate and complete recording of all dental treatment and the correct charting of 



teeth. 



--BuMed. W. J. C. Agnew, 



To: All Ships and Stations. 

Subj: Army Publications, Supplemental List of. 



BuMed-B-VMB 
A10-3/EW(121) 
15 Feb- 1945 



Refs: (a) BuMed Itr B-DLS, A10-3/EW(121), of 12 Apr 1944, par. 2; AS&SL 
Jan-Jun 1944, 44-490, p. 367. 
(b) EXOS Itr AO(Pub)FMK:mfp, of 25 Feb 1944. 

1. In accordance with reference (a), a supplemental list of U. S. Army publica- 
tions treating medico- military subjects available to date for limited distribution 
is as follows: 

LIST OF PUBLICATIONS FOR TRAINING 









Title 


Date 


TB 


QM 


20 


Prevention of Mildew - Enemy of all Equipment 
in the Tropics 


15 Jul 44 


SB 


8 


-15 


Replacement for, Disposition of and Recapture 
of Medical Department Unserviceable Prop- 
erty and Excess Serviceable Property 


20 Oct 44 


TB 


MED 


18 


Medical and Sanitary Data on Dutch New Guinea 


10 Mar 44 


TB 


MED 


30 


Medical and Sanitary Data on Formosa 


8 Apr 44 


TB 


MED 


31 


Scrub Typhus Fever CTsutsugamushi Disease) 


11 Apr 44 


TB 


MED 


52 


Medical and Sanitary Data on Denmark 




TB 


MED 


57 


Medical and Sanitary Data on Guam 


23 Jun 44 


TB 


MED 


75 


Medical and Sanitary Data on the Lesser Sunda 
and Southwestern Islands 


14 Oct 44 


TB 


MED 


83 


Medical and Sanitary Data on the Izu, Bonin, 
Kazan, and Marcus Islands 


7 Aug 44 


TB 


MED 


88 


Medical and Sanitary Data on Khabarovsk Krai 
and Maritime Krai (Far Eastern Territory) 
U.S.S.R. (Excluding Kamchatka Oblast) 


29 Aug 44 


TB 


MED 


93 


Medical and Sanitary Data on the Dodecanese 
Islands 


16 Sep 44 


TB 


MED 


98 


Medical and Sanitary Data on Tunisia 


3 Oct 44 


TB 


MED 101 


Use of Bal in Oil and Bal Ointment in Treat- 










ment of Systemic Poisoning Caused by 










Lewisite and Other Arsenical Blister Gases 


4 Oct 44 


TB 


MED 102 


Medical and Sanitary Data on Java 


10 Oct 44 


TB 


MED 104 


Use of Bal in Oil for Treatment of Certain 










Severe Mapharsen Reactions 


12 Oct 44 



- 22 - 



tm RESTRICTED 



TB MED 105 Medical and Sanitary Data on th.e Andman 

' and Micobar Islands -r - - • ' 11 Oct 44 

TB MED 107 Medical and SanitaryData on Czechoslovakia 23 Oct 44 

TB MED 108 Medical and SanitaryData on the Ryukyu Islands 24 Oct 44 

TB MED 109 Medical and Sanitary Data on Ceylon 28 .0ct 44 

TB MED 111 Medical and Sanitary Data on the Marshall Islands 3 Nov 44 

TB MED ll^t Medical and Sanitat^f DM«'SM30»:ts' ' •■MirfT Nov 44 - 

TB MED 114 Immunization 9 Nov 44 

TB MED 116 Use of War Wound Moulages in Teaching 

Emergency Medical Care and First Aid . ' 18 Nov 44 

TB'MED 118 Medical and Sanitary Data on Hainan- ^;r-o--rT : ■ Nov 44 

TB MED 119- Bacillary Dysentery Nov 44 

TB MED 120 Medical and Sanitary Data on Sumatra . • Dec 44 

TB MED 123 Medical and Sanitary Data .on..t|ie Azores . Dec 44 

TB MED 125 Medical arid Sanitary Data* Css Corsica ' ■ Dee 44 

2. Medical Department activities may obtain copies of any of these listed 
Army publications by letter request directed to BuMed. These letter requests 
should give the catalog number, title and date of publication, and number of 
mp&m' smSM.i&T S-m&nt^farldd as of 1 January and 1 July. 

--BaMed* W. Jp C. 4Wis?. 

9{C 3|C 3(C i^! 3{C Sfc 

To: All Ships and Stations Concerned With Aircraft. BuMed-c^-BHL 

Subj: Quarantine with Reference to. Air craft and Pas- 
sengers. „ 10 Feb 1945 

Re#-'''- CsO' BuMed Itr P2-l/A21(024) of 9 Aug 1944; N.D. Bui. of 31 Aug 1M4, 
44.-991 j i^M fte^ &f:ii)p-.' II. - • •■ . ■ 

1. Foreign Quarantine Division Circular Number 71, Revised 27 Nov 1944, in- 
cludes the Territory of Hawaii in the list of places from which Jtassengers may 
fly into the continental United States, its Territories, and possessions without 
application of quarantine r^trictions, in the absence of quarantinable diseases 
or epidemic conditions. 7^" - 

2. Therefore, this area (Territory of Hawaii) is hereby added to the list of 
places contained in the last paragraph of app. 11 of the above reference. Passen- 
gers embarking from the Territory of Hawaii, if they fulfill the conditions of the 
above reference, will not obtain medical certificates, but their names will be 
©nt@r#t 'In the '^'fe&iteine Declaratton - Air traft . " 

•[ --BuMed. W. J. C. Agnew. 

Approved: : " • * - 

■ "Aubrey W. Fitch, r^ns-.^n;:.; .j,iD 

Deputy ChleJ-^<Tl^63PP.lTQpi#3?ations (Air) 



i^E :t: 4^ 4^ =^ ^ 
_ 9?? _ 



Burned News Letter, Vol. 5, No, 7 



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To: 



Subj: 



All Ships and Stations. 



Penicillin Therapy, Report of Results of. 



BuMed-WM-CM 
L8-2/Jj57(042-43) 
17 Feb 1945 



Ref: (a) BuMed Itr BuMed-WM-CM, L8-2/JJ57(042-43) of 13 Feb 1945; 
N.D. Bui. of 15 Feb 1945, 45-148. 

End: (A) BuMed Itr BuMed-WM-ERT, L8-2/JJ5 7(042-4 3) of 28 Oct 1944. 

1. Routine reporting of penicillin therapy in all diseases except syphilis was 
discontinued by enclosure (A). However, reports of unusual diseases treated 
by penicillin and reports of unusual results or reactions shall be submitted to 
BuMed. 

2. Cases of syphilis treated by penicillin shall be reported as outlined in 
reference (a). --BuMed. W. J. C. Agnew. 



Subj: Penicillin Therapy; Report of results of. 

Refs: (a) BuMed Itr BuMed-X-FEW-III, L8-2/Jj57(042-43) , 7 Jan 1944, in 
Burned News Ltr, 21 Jan 1944, Vol. 3, No. 2, p. 15. 
Cb) BuMed ltr BuMed-X-FEW-III, L8-2/JJ57(042-43) , 31 May 1944, 
in Burned News Ltr, 9 Jun 1944, Vol. 3, No. 12, p. 32. 

1 . More than five thousand reports on the use of penicillin in conditions other 
than gonorrhea and syphilis have been received. This is considered adequate 
information regarding the effectiveness of penicillin therapy, except in several 
conditions listed below. Routine reports, therefore, in all other cases as re- 
quired by paragraph 12 of ref (a), including reports from those hospitals indi- 
cated in ref (b) , shall be discontinued.' 

2. If any of the below listed diseases are treated with penicillin, reports shall 
be made on penicillin therapy report form, NavMed 140: 

A. Hemolytic Streptococcus Pneumonia F. All Eye Conditions 

B. Mycoses G. Infectious Mononucleosis 

C. Arthritis (specify type) H. Yaws 

D. Meningitis (specify type) I. SubacuteBacterial Endocarditis 

E. Gas Gangrene 



Enclosure (A) 



BUMED-WM-ERT 
L8-2/Jj57(042-43) 



28 Oct 1944 



To: 



MedOfCom, NavHosps (Continental Limits). 



--Ross T. Mclntire. 



- 24 



CJSXlif^'^^^^ 'Bwo£iMi^m-t^m^^mi..^^SiBntf^ RESTRICTED 

To: All Ships and Stations. BuMed-W-SCW 

. . P16-3/P3-2 

Sabtf^'.* ■• Transfer of Hospital Patients .withia the Con- BuPers P3-2 

tlnental Limits, Mar Corps -1865-90 

21 Feb 1945 

Ref: (a) Art. D-7017C3), BuPers Manual. ... ■ . 

W) BuNav 312-SP, P3-5C80), of 18 Mar 1942. 
•■ . M CMC 1865-90, AN-322-ed, of 6 Jul 1942. 

■ (d) CMC 1865-90, AN-322-js, of 7 Jul 1942. 

■ (e) BuPers-630-NDl6, of 5 Mar 1943. . - . . 
Cf ) BuPers-630-NDl, of 30 Jun 1943. 

^ (g) BuPers -66-MSW, of 4 May 1944. 

(W CMC 2445/70-5780, DFB-532-hcm, of 2 May 1944. 
CD CMC 1865-80-40, serial' DFA-41 5 -gc, of 4 Jul 1944. 
Cj) BuPers-P3-2, 319-HBS, of 13 Jul 1944. 
Ck) BuPers -6303-DW, of 25 Sep 1:943. 
(1) BilMed-WH-ERT, Pl6-3/P3-2(082) , of 12 Oct 1944. 
(m)BuPers-6303-DW-l, P3-2, of 2 Dec 1944. 
(n) BuPers Circ Ltr 296-44; N.D. Bui. of 30 Sep 1944, 44-1144. 
(o) CMC Letter of Instruction 865. 
■ (p) BuPers Circ Ltr 367-44; N.D. Bui. of 15 Dec 1944, 44-1398. 

(q) Joint ltr BuMed-BuPers, Pers-66-ELM, P3-5, BuMed-RP-OIM^ 
. of- 12 Jan 1945. . . - , .- ... 

1. References a, b, c, d, e, f, g, h, i, j, k, 1, and m are canceled and all instruc- 
tions in conflict with this directive are modified accordingly. 

2. The following instructions shall govern the transfer of patients between naval 
and/or naval convalescent hospitals within the continental limits for purposes 

of (a) special treatment, Cb) transferring overseas casualties to hospitals 
nearer home, and Cc) relieving crowded conditions in hospitals, 

3. The interhospltal transfer of all patients must have prior approval of the 

Bureau of Medicine and Surgery except transfers within the same naval district 
which require only the approval of the commandant of that naval district. Ref- 
erence (p) modified accordingly. 

. -^v. - ■ ■ ■ ' 

4. In order to expedite the movement of patients, action by board of medical 
survey is dispensed with except for transfers outlined in paragraphs 5 and 6, 
and medical officers in command are authorized to issue travel orders inci- 
dent to such transfers upon receipt of approval from the Biireau of Medicine and 
iSurgery or the cMstrict commandant, as appropriate, reference Cp). Mode of 
travel wUl.be a matter of local decision in each-GaiB©. ■• ■ 

5. Action by a board of medical survey is requirit'pbior to the transfer of 
'psychotic patients. In accordance with authorization in reference (q), medical 

officers in command of U. S. naval hospitals aM iwal aomvalBSGent hospitals 



Burned News Letter, Vol. 5, No. 7 RESTRICTED 



(continental U. S.) may take final action on reports of medical survey that 
recommend transfer of psychotic patients to another naval hospital or to the 
U. S. Public Health Service Hospital, Fort Worth, Texas. The original and one 
copy of the report should be forwarded to the Bureau of Medicine and Surgery 
for record purposes only. 

6. BuMed and BuPers or Mar Corps approval of medical survey is required 
for transfer of patients to non-naval hospitals such as Army and Navy General 
Hospital at Hot Springs, Arkansas, and the Georgia Warm Springs Foundation. 

7. All requests to BuMed for transfer shall state the reference under which 
transfer is requested, the number, type (medical, surgical, NP), condition 
(stretcher, ambulant, convalescent), and whether officer or enlisted personnel. 
BuMed will approve or modify requests according to availability of beds, and 
will furnish information copy of action taken to naval hospitals concerned. Re- 
quests for transfer to a hospital nearer home, of other than overseas casual- 
ties, will be approved only in unusual circumstances. 

8. The transferring activity shall advise the receiving activities in each in- 
stance of transfers with respect to scheduled time of arrival, number of stretcher 
cases, number of cases requiring special handling, and other information con- 
sidered relative to an orderly and efficient handling of patients at point of re- 
ception. 

9. The movement of overseas casualties from ports of entry upon arrival will 
be under the operational control of the district commandant concerned and will 
be made as outlined in paragraphs 3 and 4. 

10. When effecting transfers under this authority appropriate travel orders 
will be issued and a copy of orders issued to officers will be forwarded immedi- 

I ately to BuPers or Mar Corps as appropriate. Forward copy of page 9 of service 
record to BuPers in the cases of enlisted naval personnel and, in addition, 
NavMed HC-3 in cases of enlisted members of the Hospital Corps to BuMed, 
Notify Marine Corps activity at which staff returns of Marine enlisted personnel 
are carried as to hospital to which transferred. The commanding officer of the 
Marine Corps activity concerned will, upon receipt of such notification, transfer 
enlisted personnel by staff returns to the Marine Corps activity nearest the new 
hospital. 

--BuMed. W. J. C. Agnew 

— MarCorps. A. A. Vandegrift. 

--BuPers. Randall Jacobs. 

Approved: 21 Feb 1945 
--Ralph A. Bard, 

Acting Secretary of the Navy. " ■ ' . 



- 26 - 



RESTRICTED 



To: All Ships and Stations. BUMED-T 

:c, - - ^ P2-3(061) 

Satsff: • Spectacles for Navy, Marine Corps, and Coast Guard 

Personnel on Active Duty. 12 Feb 1945 

End: (A) Initial List of Optical Dispensing Agencies. 

1. Personnel of the Navy, Marine Corps, or Coast Guard on active duty will 
be provided with new spectacles when required, or with lenses and/or. frames 
as replacements for dafnage or loss in the performance of duty. This program 
will be eiibt3?ely at GoverhmelEt mw^mBm. 

2. Applicants for spectacles or optical repair service should apply in person, 
when practicable, at a designated hospital or dispensary, either with a pre- 
scription for correction lenses or a request for refraction or repair service 
signed by a naval medical officer except as provided in pars.' 13 and 14. 

3. The naval medical^ officer signing the prescription or the request for re- 
pair or replacement service must determine thfe need for the spectacles or 
service on the basis of the applicant's use of them in the performance of his or 
her official duties. Special cases requiring unusually close work for which bi- 
focals are not adapted will be issued the number of pairs of spectacles deter- 
mined necessary by the refractionist. The refractionist will not prescribe - 
lanses in 1/8 diopter variations but will prescribe to the nearest 1/4 diopter. 

4. In the case of each applicant the result of the examination shall be entered 
in Health Record under Special Duty Abstract H-3, Refractions. The prescrip- 
tion for spectacles with additional data concerning frame measurements shall 
be entered in detail on a Medical History Sheet H-8. In case spectacles are 
found to be not required an entry to this effect shall be made. 

B . Repairs and replacemGrrt#^ *Mli, be made only by materials described in 
Specifications, see par. 12. If this would result in right and left lenses or 
frames being unmatched in size, shape, or color, new spectacles will be pro- 
vided. . , - 

6. Through the medium of optical service units, base and mobile types, 
spectacles repair and replacement facilities are available in various theaters 
of operation. The optical repair facilities are attached to certain fleet and 
base hospitals and hospital ships and shall be used by naval, Marine and Coast 
Guard organizations operating abroad in areas served by these facilities. 
Naval, Marine and Coast Guard organizations located beyond the continental 
limits, in areas which are not served by optical service units, may request 
that arrangements be made for service by mail'through designated hospitals 
and dispensaries in parts of the continental United States nearest to the areas 
for which service is desire4>,iSiiQfc-r#|ia^1a^#j^^:aig^'^te©ugh t^^ nearest 
district medical officer. 

- 27. - 



Burned News Letter, Vol. 5, No. 7 



REgTRICTEP 



7. When personnel requiring service present a properly signed request or 
prescription at one of the designated hospitals or dispensaries, personnel of 
the dispensing unit will take facial measurements, prepare an order form list- 
ing all the information necessary as to the type of optical service needed, and 
forward the order to the contractor optical shop. Spectacles will be returned 
to the dispensing unit, after completion, by the contractor optical shop, and 
delivery of the spectacles will be made. 

8. Personnel from visiting ships in port shall be permitted to obtain optical 
service from the designated hospital or dispensary nearest the port, 

9. Designated activities for optical dispensing units will start this program 
when informed by their respective naval districts that applicable contracts 
have been awarded. 

10. The designated optical dispensing activities will initiate purchase orders 
through regular channels, and all payment and accounting procedures will fol- 
low the same routine as other sundry purchase of supplies under contracts. 
At naval hospitals, glasses and incidental services procured for in-patients 
will, upon issue, be charged to General Ledger Account 10, Operating Expense 
and Expense Analysis Account ElOg, Wards. When furnished to staff personnel 
and personnel from other commands, the cost thereof will be charged to General 
Ledger Account 13, Navy as a Whole, and Expense Analysis Account E302, Out- 
patient Services. At other activities the cost of all glasses and incidental 
services procured will be expended under the caption "Miscellaneous Medical 
Department Supplies" and reported on line 34 of Statement of Receipts and Ex- 
penditures of Medical Department, NavMed E, 

11. The designated optical dispensing activities should request increase in 
allotments, under the subheads applicable to orthopedic and prosthetic appli- 
ances, to the extent that the funds available in the total quarterly apportionments 
of existing allotments are not sufficient to cover' the additional expenditures 
arising under this program. 

12. Specifications: Spectacles to be issued, either as new eyeglasses or as 
replacements, shall conform to the following specifications: 

(a) Frame: Shall be of plain bridge design, wrap-around or semi-wrap- 
around, ful-vue construction, rocking zylonite pads, riding bow comfort cable 
temples, double screw split joint end pieces, and of 1/10 12K yellow-gold-filled 
material in either smooth, channel, beaded, or lightly engraved finish. 

Cb) Lenses: Shall be of white toric and/or meniscus form, single vision or 
Kryptok, ground and polished from high-quality ophthalmic lens blanks manu- 
factured to the quality standards of first quality Balcor, Centex, or Rontor 
lenses or their equal. Tolerances for surface quality, power, centering, and 
thickness shall be those regularly accepted for lenses of that type in good com- 
mercial practice. 

- 28 - 



BiitM.M@WS. M*tS(»>\^^^ RESTRICTED 



13. When on duty where refraction by a naval medical officer cannot be ob- 
tained, the services of a qualified medical officer of the Army or of the Public 
Health Service should be utilized if available. Request for this service should 
be signed by a naval medical officer, if practicable, otherwise by the command- 
ing officer or officer in charge, and the procedure for obtaining spectacles shall 
be as provided in paragraph 14. 

14. Personnel on independent duty and unable to avail themselves ®f Navy, 
Army or Public Health Service facilities should request authority for "civilian 
refraction from the Bureau via official channels, stating the need and giving 
the estimated cost. If approved, the prescription with the proper facial meas- 
urements together with the Bureau's authorization shall be sent to the optical 
dispensing unit designated. On receipt, the spectacles should be properly 
checked and fitted. Bill in duplicate covering cost of refraction should be sub- 
mitted to thB Bureaii for payment bearing the following certificate and acknow- 
ledgement: "Certified correct and just; payment not received" (signed by 
person rendering the service); "Receipt of services as above acknowledged" 
(signed by person receiving the services). --BuMed. W. J. C. Agnew. 

IMCLOSURE (A) - „ .1 

INITIAL LIST OF OPTICAL DISPENSING AGENCIES 
FIRST NAVAL DISTRICT 

U. S. Naval Hospital, Chelsea, Mass. 

U. S. Naval Dispensary, Davisville, R. iy ,'J 

U. S. Naval Hospital, Newport, R. 1. . j 

U. S. Naval Hospital, Ports nioutji, N.,H. 
THIRD NAVAL DISTRICT 

U. S. Naval Hospital, Brooklyn, N. Y/ •- ' -. ' • " 

' U.S. Naval Hospital, Sampson, N. Y. 

U. S. Naval Hospital, St. Albans, N. Y. 
FOURTH NAVAL DISTRICT 

U. S. Naval Hospital, Philadelphia, Pa." '"^ . . ,, .-. •. 

SEVERN RIVER NAVAL COMMAND 

U. S. Naval Hospital, Annapolis, Md. 
POTOMAC RIVER NAVAL COMMAND 

U. S. Naval Hospital, Bethesda, Md. • : : 

U. S. Naval Dispensary, WaihiiSgton, D. C. • . . 

FIFT H NAVAL DISTRICT \ ■ 

U. S. Naval Hospital, Bainbridge, Md. 

U. S. Naval Dispensary, Little Creek, Va. 

U. S. Naval Hospital, New Rivm3*,-H.- €. 

U. S. Naval Hospital, Portsmouth, Va. 

U. S. Naval Hospital, Quantico, Va. 
SIXTH NAVAL DISTRICT . ' ' • 

-ifvB. Nav-al Dispensary, Nff^T:Ml»'"Qiilt6tf;>^ 

U. S. Naval Hospital, Charleston, S. C. -•, • • 

U. S, Naval Hospital, Parris Island, s. C. 

' ' - - 29 - 



Burned News Letter, Vol. 5, No. 7 RESTRICTED 



SEVENTH NAVAL DISTRICT 

U. S. Naval Hospital, Jacksonville, Ela. 
. U. S. Naval Hospital, Key West, Fla. 

U. S. Naval Hospital, Pensacola, Fla. 
■ EIGHTH NAVAL DISTRICT 

U. S. Naval Hospital, Corpus Christi, Texas 

U. S. Naval Dispensary, Adv. Base Depot, Gulfport, Miss. 

U. S. Naval Hospital, Houston, Texas 

U. S. Naval Hospital, Memphis, Tenn. 

U. S. Naval Hospital, New Orleans, La, 

U. S, Naval Hospital, Norman, Oklahoma 
NINTH NAVAL DISTRICT 

U. S. Naval Dispensary N.T.S. (Armed Guard) Randolph Street and Lake 
Front, Chicago, 111. 

U. S. Naval Hospital, Great Lakes, 111. 

U. S. Naval Dispensary, Navy Pier, Chicago, 111. 

U. S. Naval Dispensary, Naval Air Sta., Glenview, 111. 
ELEVENTH NAVAL DISTRICT 

U. S. Naval Hospital, Camp Pendleton, Calif. 

U. S. Naval Dispensary, Long Beach, Calif. 

U. S. Naval Hospital, Long Beach Calif. ^ 

U. S. Naval Hospital, San Diego, Calif. 

U. S. Naval Disp., Marine Corps Base, San Diego, Calif. 

U. S. Naval Disp., Naval Air Station, San Diego, Calif. 

U. S. Naval Disp., Naval Repair Base, San Diego, Calif. 

U. S. Naval Disp., Naval Training Sta., San Diego, Calif. 
TWELFTH NAVAL DISTRICT 

U. S. Naval Hospital, Mare Island, Calif. 

U. S. Naval Hospital, Oakland, Calif. 

U. S. Naval Hospital, Shoemaker, Calif. 

U. S. Naval Dispensary, Nav, Adv. Base Dep., San Bruno, Calif. 
U. S. Naval Dispensary, Nav. Tr. & Dist, Cen., Shoemaker, Calif. 
U. S. Naval Hospital, Treasure Island, Calif. 
U. S. Naval Hospital, San Leandro, Calif. 
THIRTEENTH NAVAL DISTRICT 

U. S. Naval Hospital, Astoria, Oregon 
U. S. Naval Hospital, Bremerton, Wash. 
U. S. Naval Hospital, Farragut, Idaho 
U. S. Naval Hospital, Seattle, Wash, 



To: All Ships and Stations. Pers-6303-DW 

P3-2 

Subj: Physical Examinationof Enlisted Personnel to Prevent BuMed-RP-IMB 

Physically Unqualified from Being Sent Overseas. ■ 28 Feb 1945 

Ref: (a) BuPers conf. Itr Pers-63-MJB(l), P16-3/MM, 
of 13 Oct 1944. 

- 30 - 



• -v ^, V : • mmMm^ IJ&^^^W^, ^"^.^ ■ RESTRICTED 

1 . Numerous reports of receipt of men in the overseas areas who are not 
physically qualified to perform all of their duties have been received by the 
Biia^aau of Naval Personnel. In reference Ca) corrective measures were pre- 
scribed by BuPers to certain addressees. Reference Wjit'&lsasl&Tif -^tSiiij 
Inasmuch as the instructions are incorporated herein. 

2. In view of ihe transportation involved, the unwarranted burden on medical 
facilities in advanced areas and the present congestion of men awaiting medi- 
cal or dental treatment in those areas, it is extremely urgent that steps be 
taken to prevent transferring such men overseas. 

3. The primary resp^onsibility ioT the correction of the physical defects is 
vested in the commanders of the naval: tesalilmti.ii^iliters at which recruits re- 
ceive their first training. • 

4. 1*he final responsibility for t^e e0rr©ction of the physical defects is the 
activity having control of such personnel at the port of embarkation, under in- 
structions prescribed by the appropriate district commandant to whom such 
activity is responsible. A careful physical examination of overseas drafts 
will be made at embarkation "ports and the physically unfit eliminated. 

5. It is expected that activities through which personnel pass, between the 
two responsible commands above mentioned, will conduct necessary examina- 
tions to correct, within reasonable limits, such original defects as may have 
passed inadvertently at an earlier command. Men who have minor correctible 
defects other than of a communicable or contagious nature, and for which treat 
ment has been instituted, may be considered fit for transfer if the ship or sta- 
tion to which they are being transferred has proper facilities for their further 
cmtQi should it be necamsary. A note giving the pertinent clinical facts should 
be entered in the man's health record, and in addition, a letter should be for- 
warded to the medical officer of the ship or 'station to which transfer is being 
made, showing that the man is under treatment for the minor disability. Per- 
SDimel should be considered not physically qualified for such transfisr if th@y 
present conditions of more serious import which require hospitalization or 
prolonged treatment. Thus, individuals requiring essential dental treatment, 
or presenting a large hydrocele or varicocele, or a hernia, or extensive skin 
disease are usually to be coHSidered ws&k for'bverseas duty. 

6. In order to remedy major dental defects for subject personnel, dental 
officers are directed to render adequate dental service, insofar as the faci- 
lities of their stations permit, and to make certifications on the H-4-s of sudli 
individuals as .'follows: , ■ 

"Station Date - 

Essential dental treatment, operative and prosthetic, completed this 4alf . 

• T . - Signature/' 

— BuPers, Eandall Tacobs.. ' --BuMed. W. J. G. Agnew. 



5^ 

- 31 - 



Burned News Letter, Vol. 5, No. 7 



RESTRICTED 



To: 
Subj: 

Refs". 



All Ships and Stations. 

Chlorinated Solvents, Methyl Chloride and Methyl 
Bromide - Health Hazards of. 



BuMed-X-BLW:II 
P2-3/Jj51(074) 

21 Oct 1944 



(a) BuMed Itr P2-3/JJ51(074) , X-ARP, of 28 Jul 1944, par. 2, A(l); 
N.D. Bui. of 15 Aug 1944, 44-992. 

(b) Same Itr, par. 2, C(l). ' 

1. ^Reference (a) is hereby modified to read as follows: 

"The chlorinated solvents commonly issued to the naval service are as 
follows: 

(a) Dichlorethane (ethylene dichloride) 

(b) Tetrachlormethane 

(c) Trichlorethylene 

(d) Tetrachlorethylene 

(e) Tetrachlor ethane . " 

2. It was stated in reference (a) that the above listing represented the order of 
increasing toxicity of the compounds on inhalation. This has been found to be 
erroneous as a result of subsequent review of available data. The exact se- 
quence of toxicity is very difficult, if not impossible, to determine with some 
of the substances listed. 

3. Reference (b) is hereby modified to read as follows: 

"These chlorinated solvents are colorless, not unpleasant smelling liquids 
which evaporate forming poisonous fumes. On contact with heated metal or 
open flames these compounds decompose into phosgene and hydrochloric acid 
gas which may be recognized by their odor." 

4. This will correct a possible erroneous impression from reference (b) that 
this heating effect is limited to carbon tetrachloride and trichlorethylene. 

--BuMed. Ross T. Mclntire. 



Public Health Foreign R,eDorts : 
Disease Place 
Plague Algeria 



Date 
Dec. 11-20, '44 
Jan. '45 



Typhus Fever 



Yellow Fever 



British East Africa, Kenya Jan. '45 

Morocco (French) Jan. 1-10, '45 

Senegal Jan. 1-10, '45 

Algeria Dec. 11-20, '44 

Morocco (French) Jan. 1-10, '45 

Turkey Jan. 13-20, '45 

Colombia Dec. '44- Jan. '45 



(Pub. Health Reps., Feb. 16, '45.) 



Number of Cases 
4 

7 (suspected, 

4 fatal) 
2 (fatal) 
21 
14 
89 
99 
100 

4 (fatal) 



32